| Doctor Name: | MRS. TRACEY BULLARD |
| NPI Number: | 1033463880 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 3007747 |
| Business Practice Address: | 13523 Herndon Oak Grove Rd Oak Grove, KY - 422629369 |
| Business Phone Number: | 2708399697 |
| Business Fax Number: | |
| Mailing Address: | 13523 Herndon Oak Grove Rd, OAK GROVE |
| State: | KY |
| Postal Code: | 422629369 |
| Phone Number: | 2708399697 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2012 |
| NPI Last Update Date: | 11/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SE0003X |
| License Number: | 3007747 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Emergency |
| Taxonomy Definition: | |